Aldosterone-receptor antagonists in heart failure: Insights after EMPHASIS-HF

被引：8

作者：

Jacob M.S. ^{[1
]}

Tang W.H.W. ^{[1
]}

机构：

[1] Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, 9500 Euclid Avenue

来源：

Current Heart Failure Reports | 2011年 / 8卷 / 1期

关键词：

Aldosterone antagonist; Eplerenone; Heart failure; Hyperkalemia; Spironolactone;

D O I：

10.1007/s11897-010-0046-0

中图分类号：

学科分类号：

摘要：

The recent publication of the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) has affirmed the important role of aldosterone-receptor antagonism across the spectrum of systolic heart failure. Previously restricted as therapy in patients with severe symptomatic or postinfarction heart failure, it now is being considered in less-sick patients. The precise mechanisms of benefit remain to be elucidated, in part due to the observed discrepancy between improved outcomes and the lack of reverse cardiac remodeling with aldosterone-receptor antagonists. With the probable increased use of spironolactone and eplerenone, there are concerns for increased complications, especially hyperkalemia. This risk must be balanced against the potential benefit for reduced mortality and morbidity in addition to effects of β-blockers and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and cardiac resynchronization therapy. © 2010 Springer Science+Business Media, LLC.

引用

页码：7 / 13

页数：6

共 22 条

[1]

Lloyd-Jones D., Adams R.J., Brown T.M., Et al., Heart disease and stroke statistics-2010 update: A report from the American Heart Association, Circulation, 121, (2010)

[2]

Tang W.H.W., Vagelos R.H., Yee Y.-G., Benedict C.R., Willson K., Liss C.L., LaBelle P., Fowler M.B., Neurohormonal and clinical responses to high- versus low-dose enalapril therapy in chronic heart failure, Journal of the American College of Cardiology, 39, 1, pp. 70-78, (2002)

[3]

Executive summary: HFSA 2010 Comprehensive heart failure practice guideline, Journal of Cardiac Failure, 16, pp. 475-539, (2010)

[4]

Hunt S.A., Abraham W.T., Chin M.H., Et al., 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration with the International Society for Heart and Lung Transplantation, J Am Coll Cardiol, 53, (2009)

[5]

Pitt B., Zannad F., Remme W.J., Cody R., Castaigne A., Perez A., Palensky J., Wittes J., The effect of spironolactone on morbidity and mortality in patients with severe heart failure, New England Journal of Medicine, 341, 10, pp. 709-717, (1999)

[6]

Pitt B., Remme W., Zannad F., Neaton J., Martinez F., Roniker B., Bittman R., Hurley S., Kleiman J., Gatlin M., Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction, New England Journal of Medicine, 348, 14, pp. 1309-1321, (2003)

[7]

Zannad F., McMurray J.J., Krum H., Et al., Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms, N Engl J Med, (2010)

[8]

Solomon S.D., Anavekar N., Skali H., McMurray J.J.V., Swedberg K., Yusuf S., Granger C.B., Michelson E.L., Wang D., Pocock S., Pfeffer M.A., Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients, Circulation, 112, 24, pp. 3738-3744, (2005)

[9]

Kramer D.G., Trikalinos T.A., Kent D.M., Et al., Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: A meta-analytic approach, J Am Coll Cardiol, 56, pp. 392-406, (2010)

[10]

Ezekowitz J.A., McAlister F.A., Aldosterone blockade and left ventricular dysfunction: A systematic review of randomized clinical trials, Eur Heart J, 30, pp. 469-477, (2009)

← 1 2 3 →